Fracture fixation device

ABSTRACT

Assemblies for securing a fractured or weakened bone within a subject&#39;s body are provided. The assembly includes a frame having an adjustable flexible member construct thereon. The adjustable flexible member construct is disposed in the frame such that the adjustable flexible member and the frame encircle the fractured or weakened bone.

CROSS-RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/060,007 filed on Mar. 3, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/794,309 filed on Jul. 8, 2015, now U.S. Pat. No.9,833,230, which is a continuation of U.S. patent application Ser. No.12/719,337 filed on Mar. 8, 2010, now U.S. Pat. No. 9,078,644, which isa continuation-in-part of U.S. patent application Ser. No. 12/489,168filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113, which is acontinuation-in-part of U.S. patent application Ser. No. 12/474,802filed on May 29, 2009, now U.S. Pat. No. 8,088,130, which is acontinuation-in-part of (a) U.S. patent application Ser. No. 12/196,405filed on Aug. 22, 2008 now U.S. Pat. No. 8,128,658; (b) U.S. patentapplication Ser. No. 12/196,407 filed on Aug. 22, 2008 now U.S. Pat. No.8,137,382; (c) U.S. patent application Ser. No. 12/196,410 filed on Aug.22, 2008 now U.S. Pat. No. 8,118,836; and (d) a continuation-in-part ofU.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006,which is now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.

This application is a continuation of U.S. patent application Ser. No.15/060,007 filed on Mar. 3, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/794,309 filed on Jul. 8, 2015, now U.S. Pat. No.9,833,230, which is a continuation of U.S. patent application Ser. No.12/719,337 filed on Mar. 8, 2010, now U.S. Pat. No. 9,078,644, which isa continuation-in-part of U.S. patent application Ser. No. 12/570,854filed on Sep. 30, 2009 now U.S. Pat. No. 8,303,604, which is acontinuation-in-part of U.S. patent application Ser. No. 12/014,399filed on Jan. 15, 2008.

This application is a continuation of U.S. patent application Ser. No.15/060,007 filed on Mar. 3, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/794,309 filed on Jul. 8, 2015, now U.S. Pat. No.9,833,230, which is a continuation of U.S. patent application Ser. No.12/719,337 filed on Mar. 8, 2010, now U.S. Pat. No. 9,078,644 which is acontinuation-in-part of U.S. patent application Ser. No. 12/702,067filed on Feb. 8, 2010 now U.S. Pat. No. 8,672,968, which is acontinuation of U.S. patent application Ser. No. 11/541,505 filed onSep. 29, 2006 and is now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation of U.S. patent application Ser. No.15/060,007 filed on Mar. 3, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/794,309 filed on Jul. 8, 2015, now U.S. Pat. No.9,833,230, which is a continuation of U.S. patent application Ser. No.12/719,337 filed on Mar. 8, 2010, now U.S. Pat. No. 9,078,644, which isa continuation-in-part of U.S. patent application Ser. No. 12/196,398filed Aug. 22, 2008 now U.S. Pat. No. 7,959,650, which is acontinuation-in-part of U.S. patent application Ser. No. 11/784,821filed Apr. 10, 2007 now U.S. Pat. No. 9,017,381.

The disclosures of all the above applications are incorporated byreference herein.

FIELD

The present disclosure relates to devices and methods for fracturefixation, and more particularly to holding bone fragments together topermit healing.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

After trauma or surgical intervention, there may be a need to fix bonefragments together to immobilize the fragments and permit healing.Compressive force can be applied to the bone fragments by encircling thebone fragments or bridging the fragments together across a broken orotherwise compromised portion of the bone. The compressive forces shouldbe applied such that upon ingrowth of new bone, the fragments will healtogether and restore strength to the trauma or surgical interventionsite.

Accordingly, there is a need for apparatus and methods to applycompressive force to a bone to affect healing. Further, there is a needfor an apparatus and related methods which are easy to useintraoperatively to accommodate various bone sizes, shapes, or locationsof fractures.

SUMMARY

In various embodiments, the present teachings provide an assembly forsecuring a fractured or weakened bone within a subject. The assemblyincludes a frame having a first flexible member holder and a secondflexible member holder and an adjustable flexible member constructhaving first and second ends which are passed through first and secondopenings associated with a longitudinal passage to form a loop, whereinthe longitudinal passage is pre-disposed in at least one of the flexiblemember holders of the frame.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 depicts an assembly having a closed flexible member holder and anopen flexible member holder according to the present teachings;

FIG. 2 depicts a frame having two open flexible member holders and anadjustable flexible member construct according to the present teachings;

FIG. 3 depicts an elongated frame according to the present teachings;

FIG. 4 depicts an elongated frame having a plurality of flexible memberholders according to the present teachings;

FIGS. 5A through 5C depict frames defining openings to receive fastenersaccording to the present teachings;

FIGS. 6A and 6B depict adjustable flexible member constructs accordingto the present teachings;

FIG. 7 depicts an assembly compressing a fractured or weakened boneaccording to the present teachings;

FIG. 8 depicts an assembly compressing a fractured or weakened boneaccording to the present teachings;

FIG. 9 depicts an assembly compressing a fractured or weakened boneaccording to the present teachings;

FIGS. 10A and 10B depict a frame having a post extending therefromaccording to the present teachings;

FIG. 11 depicts a frame having a post extending therefrom used in anassembly according to the present teachings;

FIG. 12 depicts a frame having a post extending therefrom where theframe defines a plurality of openings to receive at least one fasteneraccording to the present teachings;

FIG. 13 depicts a side view of a surgical method according to thepresent teachings;

FIG. 14 depicts a top view of a surgical method according to the presentteachings;

FIGS. 15A-15C depict side views of fixation of a fracture in surgicalmethods according to the present teachings; and

FIGS. 16A and 16B depict a spinal repair using apparatus according tothe present teachings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.While the present disclosure relates to fracture fixation, the apparatusand methods of the present teachings can be used with other orthopedicand non-orthopedic procedures as well.

Referring to FIGS. 1 and 2, an assembly 10 is provided according tovarious embodiments of the present teachings. The assembly 10 includes aframe 12 and an adjustable flexible member construct 14. As furtherdetailed below and as depicted in FIG. 7, regions of the adjustableflexible member construct 14 are partially disposed in the frame 12 suchthat the adjustable flexible member construct 14 and the frame encirclea bone 16 having fragments 18 and 18′ due to surgical intervention,injury, or disease. While the present disclosure may exemplify afractured bone, it is understood that any of the reasons for bonecompromise may be used with the present teachings. It is furtherunderstood that the frame 12 can be used in connection with other framesthat are placed on a different or opposing face of the bone. The variousembodiments disclosed herein can also be used to stabilize otherimplants, such as those used in revision surgery or for oncologicalpurposes.

In various embodiments, the assembly 10, assembly 110 as detailed laterherein, or the adjustable flexible member construct 14 alone is used tocompresses the respective fragments together and to affect healing atthe compromised bone 16. Bones suitable for use with the presentteachings include any bone in the body, such as the vertebrae, longbones of the arms, legs or fingers; curved bones, such as the ribs; flatbones, such as those of the wrist or feet, for example, and the like.Any bones of the legs, arms, torso, hands, feet, head, are suitable foruse with the apparatus and methods of the present teachings.

Referring to FIGS. 1 through 5C, the frame 12 includes a lower surface20, an upper surface 22, and at least flexible member holders 24A and24B defined by projections on the upper surface 22. In variousembodiments, the frame 12 can be a one-piece, integral, monolithicstructure. In various embodiments, the frame 12 can be made of agenerally rigid material. The frame 12 can be made of a plastic orpolymeric material, a metal, or a composite thereof. The frame 12 can begenerally rectangular or square, or the frame 12 can be a rounded shapeor a site-specific shape. For example, the lower surface 20 can becurved to conform to the desired bone. The frame 12 can be of asufficient length to span across a region of both fragments 18 and 18″.The frame 12 can also span the entirety of the fractured area of thebone 16 and cover healthy adjacent bone 16, or the frame can be smallerthan the fractured area of the bone 16. The frame 12 can also beelongated such that it spans beyond the length of the fracture orweakened area, such as the frames 12 shown in FIGS. 3 and 4.

The frame lower surface 20 can include a flat surface or the lowersurface 20 can be curved to accommodate the contour of the bone 16. Theupper surface 22 of the frame 12 partially defines the openings 26A and26B for the flexible member holders 24A and 24B, respectively. Theflexible member holders 24A and 24B can be channels, a post, a pin, ahole, or other means by which to retain a flexible member on the frame12. It is understood that the flexible member holders 24A and 24B neednot be formed on the upper surface 22 and that the flexible memberholders 24A and 24B can extend from the lower surface 20 and around theupper surface 22. As shown in FIGS. 4 and 8, the frame 12 can include aplurality of flexible member holders 24A-24D which can be separated by aspace 28 between the sets of flexible member holders 24C and 24A, and24D and 24B. Although various embodiments disclosed may relate to onlytwo flexible member holders, it is understood that the processes of useare generally the same for assemblies having 2 through 8, or moreflexible member holders.

Any of the flexible member holders 24A-24D can be open such that theadjustable flexible member construct 14 can be repeatedly manuallyplaced and removed, or the flexible member holders 24A-24D can be closedsuch that the adjustable flexible member construct 14 is permanentlyhoused therein and cannot be inadvertently removed without disassemblingthe adjustable flexible member construct 14. The flexible member holders24A-24D can be sized to allow the adjustable flexible member construct14 to freely slide therein. The flexible member holders 24A-24D can bepre-formed to be closed or can be initially provided as an open andsubsequently crimped or pinched closed. FIG. 1 depicts the frame havingan open flexible member holder 24A and a closed flexible member holder24B while FIG. 2 depicts two open flexible member holders 24A and 24B.

In various embodiments, the flexible member holders 24A and 24B faceeach other or are opposed. This allows for the adjustable flexiblemember construct 14 to be disposed in a first flexible member holder,for example flexible member holder 24B, wrapped around the bone 16, andthen be disposed in the other flexible member holder, for exampleflexible member holder 24A, and tightened when the flexible memberconstruct 14 is engaged such that opposing force is applied to theopposing flexible member holder to provide compression.

As shown in FIGS. 3 through 5C and FIGS. 8 and 9, the frame 12 candefine at least one opening 30 in which to attach a fastener 32 such asa pin, screw, spike, or a combination or variation thereof to bone. Theframe 12 can include a plurality of fastener openings 30 to accommodatemultiples of the same or different fasteners 32. The fastener openings30 can be placed along the periphery of the frame 12 as shown in FIGS.5A through 5C, or the fastener openings 30 can cut through the lowersurface 20 and upper surface 22 of the frame 12. The fastener openings30 can be evenly placed on or about the frame 12, as shown in FIG. 5Band FIG. 9, or they can be asymmetrically placed on or about the frame12, as shown in FIG. 5A. It is understood that the fastener openings 30can be placed anywhere along the frame 12 at any angle and can be placedwithin the interior of the frame 12.

Referring to FIG. 1, the frame 12 can be used to hold the adjustableflexible member construct 14 as depicted in FIGS. 6A and 6B. Theadjustable flexible member construct 14 is fashioned from a flexiblemember 34 made of any biocompatible material that is flexible and canfold around and secure a bone 16. Exemplary materials include, but arenot limited to, non-resorbable polymers, such as polyethylene orpolyester, resorbable polymers, metals, and various combinationsthereof. The materials can include those formed into a monofilament,multiple filaments, cables, and the like. In various embodiments, theadjustable flexible member construct 14 is made of a hollow material toallow for the appropriate folding and tensioning. In variousembodiments, the adjustable flexible member construct 14 can be asuture. In such embodiments, the suture can be hollow or a braided ormultiple-filament suture structure. In various embodiments, theadjustable flexible member construct 14 can define a substantiallytubular hollow shape.

To form the adjustable flexible member construct 14, a first end 36 ofthe flexible member is passed through the first aperture 38 and throughlongitudinal passage 40 and out a second aperture 42. The second end 44is passed through the second aperture 42, through the longitudinalpassage 40 and out the first aperture 38. In various embodiments, thefirst and second apertures 38 and 42 are formed during the braidingprocess as loose portions between pairs of fibers defining the flexiblemember 34. Passing the ends 36 and 44 through the apertures 38 and 42forms loops 46 and 46′. The longitudinal and parallel placement andadvancement of the first and second ends 36 and 44 of the flexiblemember 34 within the longitudinal passage 40 resists the reverserelative movement of the first and second portions 48 and 50 of theflexible member 34 once it is tightened. A further discussion of theflexible member construct is provided in U.S. patent Ser. No. 11/541,506filed on Sep. 29, 2006 entitled “Method And Apparatus For Forming ASelf-Locking Adjustable Suture Loop” assigned to Biomet Sports Medicine,Inc., and the disclosure is incorporated by reference.

The loops 46 and 46′ define mounts or summits 52 and 52′ of theadjustable flexible member construct 14 and are disposed opposite fromthe longitudinal passage 40 such that when the summit 52 is disposed ina first flexible member holder 24A and the longitudinal passage 40 isdisposed in a second flexible member holder 24B, the summit 52 and thelongitudinal passage 40 remain stationary with respect to the frame 12,while the overall diameter of the adjustable flexible member construct14 is decreased to compress the bone fragments 18 and 18′.

The tensioning of the ends 36 and 44 cause relative translation of thesides of the flexible member 34 with respect to each other. Uponapplying tension to the first and second ends 36 and 44 of the flexiblemember 34, the size of the loop(s) 46 is reduced to a desired size orload. The flexible member 34 locks without knots due to the tensioningplaced on the first and second ends 36 and 44. At this point, additionaltension causes the body of the flexible member defining the longitudinalpassage 40 to constrict about the portions 48 and 50 of the flexiblemembers within the longitudinal passage 40. This constriction reducesthe diameter of the longitudinal passage 40, thus forming a mechanicalinterface between the exterior surfaces of the first and second portions48 and 50, as well as the interior surface of the longitudinal passage40. This constriction causes the adjustable flexible member to“automatically” lock in a reduced or smaller diameter position.

In use, the assembly 10 is formed by coupling the adjustable flexiblemember construct 14 to the frame 12. The lower surface 20 is placed suchthat it abuts the bone fragments 18 and 18′. In embodiments where atleast one flexible member holder 24A or 24B is closed, the summit 52 isplaced in the open flexible member holder 24B opposite the longitudinalpassage 40 disposed in the opposing closed flexible member holder 24A.The flexible member free ends 36 and 44 are engaged and pulled in thedirection of the arrow shown in FIG. 7 such that the diameter of theloop 46 is reduced and the bone fragments 18 and 18′ are compressed. Inembodiments where the longitudinal passage 40 is not pre-disposed in theclosed flexible member holder 24A or where both flexible member holdersare open, the longitudinal passage 40 and the summit 52 are placed inthe respective, opposing flexible member holder and then the free ends36 and 44 are engaged to tighten the adjustable flexible memberconstruct 14 and secure the bone fragments 18 and 18′. No additionalsteps, such as knot tying, are required to secure the adjustableflexible member due to the automatic locking feature.

Turning to FIGS. 10A through 15C, in still other embodiments, anassembly 110 is provided. The assembly 110 shares several similaritieswith the assembly 10 detailed above. It is understood that the assembly110 and the assembly 10 can have interchangeable features and thediscussion of separate features on the respective assemblies is notintended to be a limitation of the present teachings.

The assembly 110 includes a frame 112 and an adjustable flexible memberconstruct 114. The frame 112 includes a lower surface 120, an uppersurface 122, and at least one flexible member holder, depicted as a post124, thereon about which the adjustable flexible member construct 114can be secured.

The post 124 sits proud to the upper surface 122 of the frame. The post124 can be centered on the frame 112, or the post 124 can be placed atan off-center point on the frame 112. The post 124 can be generallysmooth and cylindrical as shown in FIGS. 10A and 10B, or the post 124can be a squared or have any other suitable geometry. The post 124 caninclude surface features by which the adjustable flexible memberconstruct 114 can be disposed in or through, such as a notch, under cut,groove, or throughbore. An exemplary under cut 126 is shown in FIG. 10A.

The frame 112 can have a flat profile or the frame 112 can have aslightly curved profile, such as those shown in FIGS. 10A and 10B,respectively. As shown in FIG. 12, for example, the frame 112 can defineopenings 130 to receive fasteners 132 such as those detailed earlierherein. Although a plurality of evenly spaced fastener openings 130 aredepicted on the frame 112 in FIG. 12, it is understood that the fasteneropenings 130 can be placed anywhere along the periphery of the frame112, can be placed through the center of the post 124, or can beasymmetrically placed. The fastener openings 130 can also be threaded toreceive screws. In various embodiments, the fastener openings 130 caninclude both machine threads and bone engaging threads.

In use, the lower surface of the frame 112 is placed against the bonefragments 18 and 18′. Either of the summit 52 or the longitudinalpassage 40 of the adjustable flexible member construct 14 is disposedabout the post 124. The other of the summit 52 or the longitudinalpassage 40 is partially circled about the bone 16 and is disposed on theopposite side of the post 124. In embodiments where the post 124includes a notch 126, the adjustable flexible member construct 14 can bedisposed in the notch 126 during the wrapping process. The ends 36 and44 of the adjustable flexible member construct 14 are engaged to reducethe diameter of the adjustable flexible member construct 14 about thebone 16 and thereby compress the bone fragments 18 and 18′.

Turning to FIGS. 15A-15C, in various embodiments, the assembly 210 caninclude an upper fixation element 200 and a lower fixation element 202having the adjustable flexible member construct spanning therebetweenthrough an opening 204 formed in the bone fragments 18 and 18′. Theupper fixation element 200 and lower fixation element 202 canindependently be selected from a grommet 206, a toggle 208, a button210, a screw tip 212, a screw head 214, or other similar items.

As shown in FIG. 15A, the upper fixation element 200 is a grommet 206and the lower fixation element is a toggle 208. The toggle 208 is usedto hold the longitudinal passage 40 of the adjustable flexible memberconstruct 14 and the opposing region is contained by the grommet 206 inbone fragment 18. The adjusting arms 36 and 44 are also passed throughthe grommet 206 and can be pulled to tighten the adjustable flexiblemember construct 14 and compress the bone fragments 18 and 18′ together.The upper fixation element 200 and lower fixation element 202 are shownin connection with a fixation plate 112 where the grommet 206 isdisposed in the opening 130 in the fixation plate 112. It is understoodthat the plate 112 can be used with either of the upper fixation element200 or the lower fixation element 202.

FIGS. 15B and 15C depict assemblies without the fixation plate 112 shownin FIG. 15A. Similar to the previously discussed embodiment, an opening204 is prepared in the bone fragments 18 and 18′. The opening 204 is apartial opening and does not extend all of the way through both bonefragments 18 and 18′. With specific reference to FIG. 15B, a button 210is used as the upper fixation element 200, and a screw tip 212 serves asthe lower fixation element 202. The screw tip 212 retains thelongitudinal passage 40 of the adjustable flexible member construct 14and is fixed into the bone fragment 18. At least the free ends 36 and 44and the summit 52 of the adjustable flexible member construct 14 aredisposed through the button 210, through lacing for example, and can beadjusted to provide the secured fit and bone fragment 18 and 18′fixation.

Turning to FIG. 15C, the upper fixation element 200 is depicted as atelescoping screw head 214, and the lower fixation element 202 is ascrew tip 212. The screw tip 212 is fixed in the bone fragment 18 andretains the longitudinal passage 40 of the adjustable flexible memberconstruct 14. The telescoping screw head 214 is used to retain thesummit 52 and the adjustable free ends 36 and 44 of the adjustableflexible member construct 14 and can be compressed into the distallyplaced screw tip 212 to secure the fracture.

The present teachings further provide methods for securing a fracturedor weakened bone 16 within a patient's body. The frame 12 is abuttedagainst the fractured or weakened bone 16 such that the lower surface 20sits against the bone. The frame 12 can be positioned to span acrossboth sides of the fracture. The summit 52 or the longitudinal passage 40is disposed in one of the flexible member holders 24A or 24B defined bythe frame 12. The fractured or weakened bone 16 is then encircled bypartially wrapping the adjustable flexible member construct 14 at leastpartially contained in the frame about the bone. The other of the summit52 or the longitudinal passage 40 is fixed in the second, opposingflexible member holder 24B. In embodiments where a plurality of frames12 or a plurality of flexible member holders 24A-240 are provided on aframe 12, the process can be repeated by employing several adjustableflexible member constructs 14 in various sets of flexible memberholders, for example the set 24A/24C and the set 24B/24D of FIG. 4 andFIG. 8. The process can also be repeated by wrapping a single adjustableflexible member construct 14 about the area to engage several flexiblemember holders on the different frames, such as where the frames areused in tandem across a fractured or weakened bone.

The ends 36 and 44 of the adjustable flexible member construct 14 areengaged or pulled to reduce the size of the loop 46 and to cause thesummit 52 and the longitudinal passage to press against the respectiveopposed flexible member holders. This compresses the bone fragments 18and 18′ at the compromised site. In embodiments where the frame 12 ismade of a rigid material, engaging the free ends 36 and 44 does notcause the frame 12 to stretch, lengthen, or otherwise increase in size,thereby allowing for tighter compression. In embodiments utilizingfasteners 32 or 132, the fasteners can be secured to the bone fragments,18 and 18′ before or after the adjustable flexible member construct 14is reduced about the bone 16. The flexible member constructs allowadditional tensioning of each individual flexible member constructindependently, so as to avoid any laxity that may occur to a flexiblemember construct as others are tightened.

In still further embodiments such as those shown in FIGS. 16A and 16B,the frame 112 can be attached via a pedicle screw 134 which is affixedto vertebra 136. The pedicle screw 134 is passed through the fasteneropening 130 which is defined by the post 124. The pedicle screws 134 canbe linked together using the adjustable flexible member construct 14. Asshown in FIG. 16B, a single adjustable flexible member construct 14 canbe attached to two or more assemblies 10. Alternatively, as shown inFIGS. 16A and 16B, multiple adjustable flexible member constructs 14 canbe attached to one or more pedicle screws 134.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. For example, any ofthe above mentioned surgical procedures is applicable to the repair ofother body portions. For example, the procedures can be equally appliedto orthopedic repair of wrists, fingers, legs, ankles, and other bonesand also to non-orthopedic repairs. Such variations are not to beregarded as a departure from the spirit and scope of the invention.

What is claimed is:
 1. A bone compression assembly, comprising: a firstfixation element securable in a first bone portion, the first fixationmember including a proximal screw head and a distal portion that extendsfrom the proximal screw head; a second fixation element securable in asecond bone portion, the second fixation member including a distalthreaded portion and a proximal receiving portion into which the distalportion of the first fixation element can be received; and an adjustablesuture construct extending between the first fixation element and thesecond fixation element, the adjustable suture construct including asuture with a free end that extends longitudinally through alongitudinal passage in the suture to form an adjustable loop thatincludes a summit, wherein the adjustable suture construct is coupled tothe first fixation element and the second fixation element such that,with the free end extending through the longitudinal passage in thesuture to form the adjustable loop, the free end can be pulled throughthe longitudinal passage to decrease a size of the adjustable loop forpulling the first fixation element and the second fixation elementtoward one another, wherein the adjustable suture construct beingcoupled to the first fixation element includes the summit being retainedwithin the distal portion of the first fixation element.
 2. The bonecompression assembly of claim 1, wherein the free end is a first freeend, the longitudinal passage is a first longitudinal passage, and theadjustable loop is a first adjustable loop, the suture further includinga second free end that extends through a second longitudinal passage inthe suture to form a second adjustable loop.
 3. The bone compressionassembly of claim 2, wherein the first free end extends through thefirst longitudinal passage without extending through the secondlongitudinal passage, and wherein the second free end extends throughthe second longitudinal passage without extending through the firstlongitudinal passage.
 4. The bone compression assembly of claim 2,wherein the first free end extends into the suture through a firstaperture in the suture, longitudinally within the suture along the firstlongitudinal passage, and out of the suture through a fourth aperture inthe suture to form the first adjustable loop, and wherein the secondfree end extends into the suture through a second aperture in thesuture, longitudinally within the suture along the second longitudinalpassage, and out of the suture through a third aperture in the suture toform the second adjustable loop, the first aperture, the secondaperture, the third aperture, and the fourth aperture all being separateapertures in the suture.
 5. The bone compression assembly of claim 4,wherein, with the first free end extending into the suture through thefirst aperture in the suture, longitudinally within the suture along thefirst longitudinal passage, and out of the suture through the fourthaperture in the suture to form the first adjustable loop and with thesecond free end extending into the suture through the second aperture inthe suture, longitudinally within the suture along the secondlongitudinal passage, and out of the suture through the third aperturein the suture to form the second adjustable loop, the first free end canbe pulled through the first longitudinal passage to decrease a size ofthe first adjustable loop without decreasing a size of the secondadjustable loop and the second free end can be pulled through the secondlongitudinal passage to decrease a size of the second adjustable loopwithout decreasing a size of the first adjustable loop.
 6. The bonecompression assembly of claim 1, wherein the distal portion of the firstfixation element extends from the proximal screw head to a distal end ofthe distal portion.
 7. The bone compression assembly of claim 6, whereinthe summit is retained within the distal portion of the first fixationelement proximate the distal end of the distal portion such that whenthe first fixation element is secured in the first bone portion thesummit is positioned in the first bone portion below an outer surface ofthe first bone portion and spaced a distance from the proximal screwhead.
 8. The bone compression assembly of claim 1, wherein the summit ispositioned inside the distal portion of the first fixation element at alocation that also allows the summit to be positioned inside theproximal receiving portion of the second fixation element when thedistal portion of the first fixation element is received in the proximalreceiving portion of the second fixation element.
 9. A bone compressionassembly, comprising: a first fixation element securable in a first boneportion, the first fixation element including a proximal screw head; asecond fixation element securable in a second bone portion, the secondfixation element including a distal threaded portion; and an adjustablesuture construct including a suture with a free end that extendslongitudinally through a longitudinal passage in the suture to form anadjustable loop that includes a summit, wherein the first fixationelement is coupled to the second fixation element with the adjustablesuture construct such that, with the free end extending through thelongitudinal passage in the suture to form the adjustable loop, the freeend can be pulled through the longitudinal passage to decrease a size ofthe adjustable loop for pulling the first fixation element and thesecond fixation element toward one another, the first fixation elementfurther including a distal portion through which the adjustable sutureconstruct extends to couple the first fixation element to the secondfixation element, the second fixation element further including aproximal receiving portion through which the adjustable suture constructextends to couple the first fixation element to the second fixationelement; the first fixation element and the second fixation elementbeing mateable together which includes the distal portion of the firstfixation element being received in the proximal receiving portion of thesecond fixation element, wherein the summit is positioned inside thedistal portion of the first fixation element such that when the firstfixation element and the second fixation element are mated together thesummit is also positioned inside the proximal receiving portion of thesecond fixation element.
 10. The bone compression assembly of claim 9,wherein the free end is a first free end, the longitudinal passage is afirst longitudinal passage, and the adjustable loop is a firstadjustable loop, the suture further including a second free end thatextends through a second longitudinal passage in the suture to form asecond adjustable loop.
 11. The bone compression assembly of claim 10,wherein the first free end extends through the first longitudinalpassage without extending through the second longitudinal passage, andwherein the second free end extends through the second longitudinalpassage without extending through the first longitudinal passage. 12.The bone compression assembly of claim 10, wherein the first free endextends into the suture through a first aperture in the suture,longitudinally within the suture along the first longitudinal passage,and out of the suture through a fourth aperture in the suture to formthe first adjustable loop, and wherein the second free end extends intothe suture through a second aperture in the suture, longitudinallywithin the suture along the second longitudinal passage, and out of thesuture through a third aperture in the suture to form the secondadjustable loop, the first aperture, the second aperture, the thirdaperture, and the fourth aperture all being separate apertures in thesuture.
 13. The bone compression assembly of claim 12, wherein, with thefirst free end extending into the suture through the first aperture inthe suture, longitudinally within the suture along the firstlongitudinal passage, and out of the suture through the fourth aperturein the suture to form the first adjustable loop and with the second freeend extending into the suture through the second aperture in the suture,longitudinally within the suture along the second longitudinal passage,and out of the suture through the third aperture in the suture to formthe second adjustable loop, the first free end can be pulled through thefirst longitudinal passage to decrease a size of the first adjustableloop without decreasing a size of the second adjustable loop and thesecond free end can be pulled through the second longitudinal passage todecrease a size of the second adjustable loop without decreasing a sizeof the first adjustable loop.
 14. The bone compression assembly of claim9, wherein the summit of the adjustable loop is retained within thedistal portion of the first fixation element proximate a distal end ofthe distal portion.
 15. The bone compression assembly of claim 9,wherein the first fixation element retains the free end of theadjustable suture construct.
 16. A bone compression assembly,comprising: a first fixation element securable in a first bone portion,the first fixation element including a proximal screw head and a distalportion that extends from the proximal screw head with a firstlongitudinal pathway passing through the distal portion and the proximalscrew head; a second fixation element securable in a second boneportion, the second fixation element including a distal threaded portionand a proximal portion with a second longitudinal pathway passingthrough the proximal portion; and an adjustable suture constructincluding a suture with a free end that extends longitudinally through alongitudinal passage in the suture to form an adjustable loop thatincludes a summit, wherein the first fixation element is coupled to thesecond fixation element with the adjustable suture construct such that,with the free end extending through the longitudinal passage in thesuture to form the adjustable loop; the free end can be pulled throughthe longitudinal passage to decrease a size of the adjustable loop forpulling the first fixation element and the second fixation elementtoward one another, the adjustable suture construct extending throughthe first longitudinal pathway in the first fixation element and throughthe second longitudinal pathway in the proximal portion of the secondfixation element with the summit of the adjustable loop beingconcurrently, positioned inside the first longitudinal pathway and thesecond longitudinal pathway.
 17. The bone compression assembly of claim16, wherein the free end is a first free end, the longitudinal passageis a first longitudinal passage, and the adjustable loop is a firstadjustable loop, the suture further including a second free end thatextends through a second longitudinal passage in the suture to form asecond adjustable loop.
 18. The bone compression assembly of claim 17,wherein the first free end extends through the first longitudinalpassage without extending through the second longitudinal passage, andwherein the second free end extends through the second longitudinalpassage without extending through the first longitudinal passage. 19.The bone compression assembly of claim 17, wherein the first free endextends into the suture through a first aperture in the suture,longitudinally within the suture along the first longitudinal passage,and out of the suture through a fourth aperture in the suture to formthe first adjustable loop, and wherein the second free end extends intothe suture through a second aperture in the suture, longitudinallywithin the suture along the second longitudinal passage, and out of thesuture through a third aperture in the suture to form the secondadjustable loop, the first aperture, the second aperture, the thirdaperture, and the fourth aperture all being separate apertures in thesuture.
 20. The bone compression assembly of claim 19, wherein, with thefirst free end extending into the suture through the first aperture inthe suture, longitudinally within the suture along the firstlongitudinal passage, and Out of the suture through the fourth aperturein the suture to form the first adjustable loop and with the second freeend extending into the suture through the second aperture in the suture,longitudinally within the suture along the second longitudinal passage,and out of the suture through the third aperture in the suture to formthe second adjustable loop, the first free end can be pulled through thefirst longitudinal passage to decrease a size of the first adjustableloop without decreasing a size of the second adjustable loop and thesecond free end can be pulled through the second longitudinal passage todecrease a size of the second adjustable loop without decreasing a sizeof the first adjustable loop.
 21. The bone compression assembly of claim16, wherein the first fixation element and the second fixation elementare mateable together.
 22. The bone compression assembly of claim 16,wherein the distal portion of the first fixation element is receivablein the proximal portion of the second fixation element.
 23. The bonecompression assembly of claim 16, wherein the summit of the adjustableloop is retained within the distal portion of the first fixation elementproximate a distal end of the distal portion.